Smallpox return could devastate population

The possibility of a biological terrorist attack using the smallpox virus is gaining national attention.

Last month when Jan Moffit, county health nurse, appeared before the Marion County Commission meeting for a routine report, the commissioners asked her about the anthrax attacks.

She replied that of course anthrax was a concern, but smallpox would be worse.

“That would be a real nightmare,” she said. “We could have a 25 percent fatality rate, and disfigurement of others.”

At that time, Moffit preferred to not have her remarks published for fear of causing a public panic about smallpox. She and others in government still hope public concern is the worst thing that could happen.

But this month the federal government is pushing an effort to have more smallpox vaccine on hand in case of an emergency, and the concerns have become more prominent in national media.

Moffit said: “We don’t have any vaccination program or plans for anything now. The government has vaccine, but they aren’t releasing it for the public through the states and the counties unless there is danger of an outbreak. It’s only released for military use now.

“Hopefully, there won’t be a problem. It’s an ugly disease, and could be bad.”

Moffit said the skin sores commonly associated with the disease also occur inside the body.

She confirmed national reports that the smallpox vaccinations received by older Americans earlier in life may not protect them now. Some still contend that lifelong immunity may persist, but Moffit said full immunity probably lasts 10 years after vaccination. Vaccinated persons may still have more resistance, or develop immunity more quickly if exposed, she said.

Our ancestors faced the possibility of cold weather outbreaks of smallpox, just as we face the possibilities of flu, chicken pox or measles, according to the Journal of the American Medical Association.

JAMA said the virus lives in an aerosolized form better with colder temperature and lower humidity with its viability going down as temperature and humidity rise.

Lin Frederickson, archivist at the Kansas State Historical Society in Topeka, said successive smallpox epidemics were recorded in Kansas in the early years with smaller numbers of cases, two or three a year in a county, reported in between, mostly in the northeast quadrant of the state.

Smallpox was such a concern that Rawlins found Kansas Health Department annual reports dealing with it from time to time, sometimes in excess of 30 pages at a time, from 1889 to 1922.

Jennifer Yuan, human biologist at Stanford University, said smallpox had become a minor threat in the United States and most of Europe by 1900 because of vaccination, although millions of people were still afflicted annually worldwide.

The last known case of variola major, the smallpox virus form that causes an average 25 percent fatalities, was reported in Bangladesh in 1975. The last case of the variola minor type that averages one percent fatalities was recorded in Somalia in 1977, she said.

The World Health Organization, which had convinced the more advanced nations that a worldwide vaccination campaign to eliminate the disease was less expensive than medical care and risk, recommended that all nations cease vaccination in 1980.

The last stocks of virus were kept at the Institute of Virus Preparations in Moscow, Russia, and the Centers for Disease Control and Prevention in Atlanta, Ga.

Since then, JAMA said, Ken Alibek, deputy director of the Soviet Union’s civilian bioweapons program, has reported that the Soviets began mass production of the smallpox virus for use with bombs and intercontinental ballistic missiles.

Alibek claims that even now the Russians are doing research to develop more virulent and contagious strains. There are unconfirmed reports that they may have succeeded in some type of hybrid merging of smallpox and ebola which would allow ebola to be spread without its requirement for blood transmission.

JAMA said Russians at their center frequently haven’t been paid, raising a fear that they may have sold smallpox virus to other nationals such as Iraqis.

JAMA said the virus could be introduced by spraying it from an aerosol can with the possibility that those first infected may have spread it to many times their number before it is known they have it.

JAMA said the disease may be spread through expelled respiratory droplets in the air or by contact. The main infectious time is when the first victims develop a rash, but Moffit explained that the rash may be so subdued at first as to not be noticeable.

Yuan said transmission of the disease is possible with no apparent symptoms. The disease may include temperatures over 101 degrees and physical deterioration.

JAMA said the virus may live for a much greater time in the scabs of victims, but is not especially infectious then because it is bound tightly in the fibrin matrix.

The first known use of smallpox as a weapon was during the French and Indian War from 1754 to 1767, when soldiers distributed blankets that had been used by smallpox victims to enemy Indian tribes resulting in a 50 percent death rate, JAMA said.

The world’s first vaccination was given in 1796 by Edward Jenner, a country doctor in England, to 8-year-old James Phipps after Jenner noticed that milkmaids infected by cow pox from the cows they worked with gained immunity to smallpox.

He proved the immunity by injecting Phipps later with live virus.

Moffitt said worldwide eradication was helped because stable vaccine without refrigeration could be scratched into the skin with a bifurcated needle reducing handling cares.

Moffit agreed that most health professionals have the hope that grandparents only need to be concerned with showing the children the vaccination scar on their arm as historical evidence of the smallpox concern that once existed.

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